The American Society of Nephrology (ASN) released its latest Kidney Health Guidance (KHG): Conservative Management in People with Kidney Failure, in the Journal of the American Society of Nephrology (JASN). The new KHG and companion Executive Summary provide evidence-based support for the core components of the conservative management care pathway, including customized CKD care to align with a person’s values and goals, symptom management, and navigation of care transitions through the end of life.
The new KHG—which focuses on the role of conservative management as a proactive therapeutic option for people with kidney failure and covers key concepts that underpin this approach—emphasizes the importance of shared decision making in providing care, engaging care partners, and collaborating across disciplines. In addition, the Executive Summary, a first for the ASN KHG series, is provided to further accelerate the practical application of this model.
People with kidney failure have a broad range of available treatment options, including hemodialysis, peritoneal dialysis, and kidney transplantation. Conservative management offers a “4th pathway” for people with kidney failure, as well as their care partners and health care professionals, to navigate treatment and transitions through the end of life that emphasize patient autonomy and quality of life.
“For many patients, particularly older patients who may be managing multiple chronic conditions, conservative management of kidney failure can be an approach that better reflects their needs and priorities,” explains Crystal A. Gadegbeku, MD, FASN, Chair of the Department of Kidney Medicine in the Medical Specialties Institute within the Cleveland Clinic Health System and President-Elect of the American Society of Nephrology.
“For some patients, the conservative approach can be superior to dialysis in terms of life satisfaction, symptom burden, and reduced hospitalization. Still, we must overcome the stigma that foregoing dialysis or transplant is a failure as we work to build the educational, reimbursement, and training infrastructure needed to support conservative management as a proactive and just choice for people with kidney failure,” says Dr. Gadegbeku.
“Conservative management is a dynamic, highly individualized approach that is the right fit for certain patients and, therefore, the best choice over dialysis and transplantation. In that regard, we must work to build education, training, and reimbursement infrastructure to support this approach that focuses primarily on quality of life and symptom management.”
ASN’s KHG Oversight Committee identified the need for professional guidance to clearly define best practices and establish pragmatic, relatable terms and definitions to foster meaningful discussion about this approach between patients, their care partners, and health professionals.
The KHG for conservative management encompasses a comprehensive literature review of available evidence, a synthesis of guidelines and recommendations from professional societies, and expert opinion. The KHG Workgroup on Conservative Kidney Management, comprised of experts representing nephrology, geriatrics, palliative care, bioethics, social work, and advanced practice professionals, authored the new guidance.
